Introduction: Lymphadenopathy is a common clinical problem and it has many causes one of which is malignancy which is not common in cases of lymphadenopathy but is the most serious and every effort must be done to exclude malignancy in those lymph nodes. Many diagnostic tools has been applied and at its top was histopathology, however being invasive it must be the last resort. The commonly used high frequency sonography includes B-mode sonography, color Doppler sonography and power Doppler sonography, which can display the size, location, shape and blood flow distribution of the lesion and play important roles in differential diagnosis of lymph nodes. Elastography detect the compressibility of the lymph nodes making use of the fact that malignant tissues are usually harder.Aim of the study:Elastography was investigated in this study to assess its diagnostic value in addition to ultrasound.Patients and methods:88 lymph nodes in 88 patients were subjected to either conventional ultrasonography or endosonography and elastography, they were either followed up or undergone either FNAC or biopsy.Results:Score 1 is 100% specific for benign lymph nodes and score 3 & 4 related to metastatic lymph nodes hadSpecificity100% and sensitivity95.16%.Conclusion: Elastography is a valuable add on tool to conventional ultrasound in diagnosis of malignant lymph nodes.